ABSTRACT
The antibiotic era started in the 1940s and changed the profile of infectious diseases and human demography. The burgeoning classes and numbers promised much and elimination of this major cause of human (and animal) morbidity appeared possible. Bacterial antibiotic resistance which was observed soon after antibiotic introduction has been studied extensively. Diverse mechanisms have been demonstrated and the genetic basis elucidated. The resilience of the prokaryote ecosystems to antibiotic stress has been realized. The paper presents these subjects briefly to afford an overview. The epidemiology of antibiotic resistance is dealt with and community practices in different countries are described. The role of high antibiotic usage environments is indicated. The implication of the wide use of antibiotics in animals has been pointed out. Steadily increasing antibiotic resistance and decreasing numbers of newer antibiotics appear to point to a post-antibiotic period during which treatment of infections would become increasingly difficult. This article attempts to review the global antimicrobial resistance scene and juxtaposes it to the Indian experience. The prevalence in India of antibiotic resistance among major groups of pathogens is described. The factors that determine the prevalent high antibiotic resistance rates have been highlighted. The future research activity to ensure continued utility of antibiotics in the control of infections has been indicated.
Subject(s)
Anti-Bacterial Agents/therapeutic use , Bacteria/drug effects , Bacterial Infections/drug therapy , Bacterial Vaccines , Drug Resistance, Bacterial/genetics , Humans , India/epidemiologySubject(s)
Communicable Disease Control/methods , Directly Observed Therapy , Extensively Drug-Resistant Tuberculosis , Humans , India , Clinical Laboratory Techniques/standards , Mycobacterium tuberculosis/isolation & purification , Practice Guidelines as Topic , Sputum/microbiology , Tuberculosis, Pulmonary/diagnosisABSTRACT
HLA typing was done in 25 cases of insulin dependent diabetes mellitus (IDDM) and compared with 60 healthy controls. There was a significantly increased frequency of HLA B-8, HLA B-12 and HLA DR-3 in IDDMO. The odds ratio (relative risk) of developing IDDM for HLA B-8 was 4.42 (p less than 0.10), for HLA B-12 was 3.56 (p less than 0.10) and for HLA DR3 9.75 (p less than 0.001). There was no correlation of HLA specificity with complications of diabetes.
Subject(s)
Adolescent , Adult , Case-Control Studies , Diabetes Mellitus, Type 1/immunology , Epitopes , Ethnicity , HLA Antigens/analysis , HLA-B Antigens/analysis , HLA-B8 Antigen/analysis , HLA-DR3 Antigen/analysis , HLA-DR4 Antigen/analysis , Humans , India , Risk FactorsABSTRACT
The present study describes the profile of seronegative spondarthritides (SSA) in young servicemen. SSA was diagnosed in 63 patients from a prospective study on spondyloarthropathy. The SSA group consisted of ankylosing spondylitis (AS, 40 patients), Reiter's syndrome (RS, 6) and SSA undifferentiated (SSA-U, 17). The chief clinical and radiological features of the group were due to sacro-iliitis/spondylitis, peripheral arthritis and enthesopathy. Except for RS, extra-articular features were sparse. Mucosal lesions were not evident. Radiologically, sacro-iliitis varied from 24% in SSA-U to 100% in AS, and was disproportionately less when compared to its clinical extent. Dominant lower limb arthritis (poly and oligo) was seen in AS (40%), SSA-U (88.2%) and RS (100%). HLA A and B were typed in patients and controls. HLA AI had a significant negative association (p less than 0.05) with AS and the SSA group, and its relative risk (R) was consistently low (0.2-0.3). HLA B27 was present in 65.7%, 73%, 67%, 41% and 9% of the SSA group, AS, RS, SSA-U and controls respectively (p less than 0.05). Significant R values of A and B loci antigens in disease groups are presented. When compared with available Indian literature, this study highlights the variability and overlap in the disease. Disease markers currently available have limitations in defining the various subsets of SSA.
Subject(s)
Adult , Arthritis, Reactive/blood , HLA-A Antigens/analysis , HLA-B Antigens/analysis , Humans , India , Male , Military Personnel , Phenotype , Spondylitis, Ankylosing/bloodABSTRACT
Twenty young servicemen suffering from chronic inflammatory polyarthritides (CIP) were studied. While rheumatoid arthritis (RA) was the final diagnosis in 15 patients, the arthritis remained 'unclassifiable' in the rest. An acute onset of asymmetric deforming arthritis, dominant in the lower limbs, was the usual pattern. Sacroiliitis and enthesopathy were uncommon. Extra-articular features were sparse and sub-cutaneous nodules absent. Rheumatoid factor was present in 86.7% of RA patients. Radiologic erosions were evident in 73.3% RA patients. Arthritis robustus variant of RA was diagnosed in 4 patients. HLA B27 was present in 45.5% of RA patients in this atypical setting. An overlap of RA and seronegative spondarthritides was considered probable in 3 patients.